BERKELEY, CA (UroToday.com) - Painful bladder syndrome / interstitial cystitis can be considered a chronic pain syndrome. As with other chronic pain syndromes, a great many patients are left with continued pain even after repeated treatment attempts. For these patients, long-term use of opiate medications may represent the best and most cost-effective medical treatment available. Chronic pain is increasingly recognized as a significant contributor to patient suffering and disability, provider frustration, and increased health care costs.

Schieffer and colleagues assessed the influence of medication beliefs, symptom severity, disability, mood, and psychiatric history on opiate medication misuse behaviors in 288 chronic pain patients using questionnaires and electronic medical records. Consistent with previous findings, the data indicated that a history of substance abuse is related to higher rates of medication misuse behaviors, despite similar dosages and self-rated opiate effectiveness. Misusers believed more strongly in the potential for opiate addiction and that they required higher doses than others, but also had greater belief in opiate effectiveness and the importance of free access. Although both anxiety and substance abuse history are related to medication misuse, multivariate analysis indicated that these factors can be seen as mediated by medication beliefs.

This paper highlights the complexity of using chronic narcotics for the relief of nonmalignant pain. Self-attributions regarding opiate treatment interact with anxiety to produce a high rate of opiate misuse in some populations. The institution of opiate therapy for painful bladder syndrome is not to be undertaken lightly, and expert consultation with a pain specialist would seem to be prudent before imparting on this treatment pathway.

The Journal of Pain 2005 September; 6:620-629